Provider Demographics
NPI:1235982125
Name:KOON, ABAGAIL LEE
Entity Type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:LEE
Last Name:KOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 KINGSMILL CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4848
Mailing Address - Country:US
Mailing Address - Phone:864-884-9848
Mailing Address - Fax:
Practice Address - Street 1:106 KINGSMILL CT
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4848
Practice Address - Country:US
Practice Address - Phone:864-884-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician